What PTSD costs families

On Wednesday, a soldier who had served in Iraq — and was being evaluated for post-traumatic stress disorder — killed three people and injured 16 others at Fort Hood, and then killed himself. While it isn’t certain that PTSD played a role in this shooting, two things are clear: that this is a tragic incident that will take a huge emotional toll on all of those involved and also that it is a relatively rare occurrence.

Still, there’s no doubt that families of soldiers live in fear of the impact of PTSD. And while the emotional consequences of the disorder are well documented, many don’t realize that PTSD can also have significant financial implications for families.

PTSD — a condition in which a person experiences a traumatic event and then has disturbing flashbacks, memories and/or nightmares and exhibits extreme avoidance behaviors and hyper-arousal — impacts about 14% to 20% of service members returning from Afghanistan and Iraq, but only between about 4% and 7% of the general population, says Terri Tanielian, a senior research analyst with policy think tank the RAND Corporation and the author of “Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery.”

Fort Hood shooting underscores need for mental health services

(4:44)

As the investigation into the Fort Hood shooting continues, mental health for enlisted men and women will be in focus. Psychiatrist and retired U.S. Army Brig. Gen. Loree Sutton discusses the types of resources available to members of the armed services.

The cost to treat PTSD can vary significantly — some veterans can get very low-cost care from the VA, for example, but many choose to get private care and pay out of pocket — but that can easily add up to thousands in a year. “PTSD has one of the highest costs to treat of any disorder,” says Barbara Rothbaum, a professor of psychiatry and the director of the trauma and anxiety recovery program at Emory University School of Medicine.

Cost estimates for treatment of PTSD vary widely. A study by the Congressional Budget Office based on VA data found that the average cost of treatment for PTSD in the first year was roughly $4,100 (treatment trends to get less expensive as the years go on). A study by Rand found that the annual cost ranges from about $1,160 to $4,724 per person (though this data is from 2008, Tanielian says there is little reason to think that these numbers would have changed significantly).

What’s more, some patients need years of therapy to cope with this disorder, so it’s possible that patients and their families could spend tens of thousands of dollars just on treatment, experts say. CBO data shows that four years of PTSD treatment would cost $10,000.

The costs don’t end there. Individuals impacted by PTSD also often have a higher risk of lost productivity at work, says Tanielian. PTSD sufferers “often can’t take crowds, which makes it hard to go to work or commute,” says Bella Schanzer, the chief of mental health at the John D. Dingell VA Medical Center. Rand also estimates that PTSD could cost up to about $7,000 per year per person, when you consider both the cost of treatment and lost productivity (note that lost productivity includes both lost wages and cost to the employer, which the firm did not separate out).

What’s more, those impacted by PTSD also have higher rates of other medical conditions that can also be costly to treat (though Rothbaum points out that treating PTSD often helps treat these other disorders at the same time). “With PTSD comorbidity is the rule rather than the exception,” Rothbaum says. “The majority of people with PTSD have three other disorders,” she says -- with depression, anxiety and substance abuse among the most common. Rothbaum points out that roughly half of people with PTSD also have depression and/or anxiety, and that somewhere between about one-third and two-thirds of people with PTSD also have a substance-abuse problem.

On the family level, costs also arise related to a soldier’s PTSD, as “spouses and partners and some family members often also need therapy,” says Rothbaum. Indeed, Jeffrey Borenstein, a psychiatrist and president and CEO of the Brain & Behavior Research Foundation, says that PTSD can take a “tremendous toll” on families, and that family members may also suffer from depression, anxiety and sleep disturbances related to the soldiers’ PTSD.

The bad news: While a soldier often can get free therapy from the VA, family members usually can’t, unless it’s part of a group family therapy effort or the family member can show that his or her therapy is needed to help the soldier, explains Rothbaum. That can easily cost thousands of dollars a year if the family member has to pay out of pocket. What’s more, Schanzer notes that those who suffer from PTSD also have a higher rate of divorce; the average divorce can cost $15,000 or more.

The good news: Experts say there are plenty of effective therapies that work. Schanzer says that those suffering from PTSD should seek prolonged exposure or cognitive processing therapy, as both have research backing up their effectiveness, in addition to considering medication like SSRIs as well as prazosin for nightmares. Prolonged exposure therapy involves teaching patients about common reactions to trauma and revisiting the traumatic memory to help make its impact more bearable. Cognitive processing therapy helps patients understand their trauma and develop coping behaviors.

Families also need to figure out a cost-effective way to pay for therapy. Veterans should contact the VA to determine their benefits eligibility and active duty military should contact the Department of Defense. If those organizations don’t provide care to you or your family member — or you don’t want the care they give — there are also community-based therapy groups that are often free or low-cost to join, and private insurance may cover you.

Intraday Data provided by SIX Financial Information and subject to terms of use.
Historical and current end-of-day data provided by SIX Financial Information. Intraday data
delayed per exchange requirements. S&P/Dow Jones Indices (SM) from Dow Jones & Company, Inc.
All quotes are in local exchange time. Real time last sale data provided by NASDAQ. More
information on NASDAQ traded symbols and their current financial status. Intraday
data delayed 15 minutes for Nasdaq, and 20 minutes for other exchanges. S&P/Dow Jones Indices (SM)
from Dow Jones & Company, Inc. SEHK intraday data is provided by SIX Financial Information and is
at least 60-minutes delayed. All quotes are in local exchange time.